Estimated 5 million women admitted to hospital each year following an unsafe abortion

In the developing world as a whole, an estimated five million women are admitted to hospital each year for the treatment of complications from induced abortions, concludes a study in this week’s issue of The Lancet. By comparison, in developed countries complications from abortion procedures or hospitalisations are rare.

The World Health Organization (WHO) defines unsafe abortion as a procedure to terminate an unintended pregnancy undertaken either by individuals lacking the necessary skills or in an environment that does not meet basic medical standards, or both. Women may resort to unsafe and clandestine abortion services when abortion is legally restricted or when access to safe abortion services are poor. Complications from unsafe abortion are believed to account for the largest proportion of hospital admissions for gynaecological services in developing countries but data on the magnitude of the problem are scare.

In this study Susheela Singh (Guttmacher Institute, NY, USA) compiled national estimates of abortion-related hospital admissions in women aged 15-44 years in 13 developing countries: Africa (Egypt, Nigeria, and Uganda), Asia (Bangladesh, Pakistan, and the Philippines), and Latin America and the Caribbean (Brazil, Chile, Colombia, Dominican Republic, Guatemala, Mexico, and Peru). Dr Singh found that the annual rate of admission to hospital following complications from unsafe abortion varied from a low level in Bangladesh (just under 3 per 100 women) to moderate levels in Mexico, Nigeria, and the Philippines (5-6 per 1000), to higher levels in the other nine countries (8-16 per 1000). The rates in Egypt and Uganda are the highest of the 13 countries, at just over 15 per 1000 women. The results reveal that, on average, the rate of hospital admissions is 5.7 per 1000 women per year in all developing regions, excluding China.

Dr Singh concludes: "The evidence shows that the health burden of unsafe abortion is large...the most effective way of eliminating this highly preventable cause of maternal illness and death, would be to make safe and legal abortion services available and accessible. A second, more immediately achievable, goal is to prevent unintended pregnancies in the first place through improved contraception use. These goals are a continuing and critical priority in the developing world."

###

In an accompanying Comment Marge Berer (Editor, Reproductive Health Matters) states: “Singh’s data paint a grim picture. Of the estimated 19 million unsafe abortions taking place globally, Singh estimates that more than 5 million women enter hospital care every year in Africa, Asia, Latin America, and the Caribbean for treatment of complications, in addition to the estimated 68 000 who die from their injuries. The burden of injury and hospital admission are all the worse for being almost always avoidable. When legal restrictions on abortion are reduced, the rate of deaths and morbidity decreases greatly.”